Managing re-use of returned medications

ABSTRACT

Methods for managing a return of a prepared medication are provided. In one aspect, a method includes receiving an identification of at least one returned medication delivered to a first location, and receiving an order for another medication. The method also includes determining whether the at least one returned medication is usable for completing the order of the other medication, and when the determination indicates that the at least one returned medication is usable for completing the order of the other medication, providing a notification indicating that the at least one returned medication is usable for completing the order of the other medication. Systems and machine-readable media are also provided.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser.No. 13/900,493, entitled “MANAGING RE-USE OF RETURNED MEDICATIONS,”filed on May 22, 2013, the entirety of which is incorporated herein byreference.

BACKGROUND Field

The present disclosure generally relates to medication distribution,and, in particular, relates to systems and methods for managing re-useof returned medication in a healthcare facility.

Description of the Related Art

Certain pharmaceutical drugs are compounded to fit the needs of apatient. Compounding pharmacists combine or process appropriateingredients using various tools to create a compounded pharmaceuticaldrug. For instance, compounding of sterile intravenous (IV) compoundscan be done in anticipation of medication orders based on standarddoses, or compounding can be done specific to a patient's need based ona physician order. Compounding may be done for medically necessaryreasons, such as to change the form of the medication from a solid pillto a liquid, to avoid a non-essential ingredient that the patient isallergic to, or to obtain the exact dose(s) needed of particular activepharmaceutical ingredient(s). It may also be done for more optionalreasons, such as adding flavors to a medication or otherwise alteringtaste or texture. Compounding is most routine in the case of intravenous(IV)/parenteral medication

IV fluid delivery systems are used to deliver such compounded IVmedications (or “infusion solutions”) in fluid form to patients atcontrolled rates. Many individuals suffer from acute and chronic healthproblems, the treatment of which could require regular, and sometimesextended, IV infusions. Certain treatment regimens for diseases such asinfections, cancer and even basic fluid and electrolyte replacement,require a regular and sequenced infusion of precise amounts ofintravenous medication for the patient's survival. Specifics ofintravenous infusion of medications may depend on the patient, treatmentregimen, and choices of the clinician and institution. Treating chronicmedical disorders often requires the administration of medication over along period of time according to a treatment regimen specified by amedical professional, such as a physician.

In cases of patients admitted to a healthcare facility, one or moreinfusions to be administered to a patient are prescribed by thepatient's physician. A pharmacy, generally located within the patient'shospital or healthcare facility, prepares the infusion medication orsolution according to the physician's prescription, for example, in acleanroom (e.g., an environment having a controlled level ofcontamination that is specified by a number of particles per cubic meterat a specified particle size). An appropriately trained and credentialedpharmacist places the infusion solution in a bag, bottle, syringe, orother container and labels the container. The infusion solution is thencommonly staged in a pickup location, such as a bin-sorting area. Asorting person is then responsible for placing each prepared infusionsolution into bins or delivery carts that correspond to the locationswhere the infusion solutions will be delivered, such as an IntensiveCare Unit (ICU). A delivery person retrieves the infusion solutions fromthe bins that correspond to areas of the healthcare facility to whichthat delivery person delivers. The delivery person then delivers theinfusion solutions to the appropriate locations of the healthcarefacility.

The infusion solution is then delivered to the patient's location and aclinician such as a nurse or other clinician hangs the infusion solutionfrom a rack. The nurse connects a tube between the infusion solution andan infusion pumping system and inserts a cannula at the end of the tubeinto the vessel of the patient for delivery of the infusion solution tothe patient.

SUMMARY

According to certain embodiments of the present disclosure, a system formanaging a return of a prepared medication is provided. The systemincludes a memory that includes instructions, and one or moreprocessors. The one or more processors are configured to execute theinstructions to receive an identification of at least one returnedmedication delivered to a first location, and receive an order foranother medication. The one or more processors are also configured toexecute the instructions to determine whether the at least one returnedmedication is usable for completing the order of the other medication,and when the determination indicates that the at least one returnedmedication is usable for completing the order of the other medication,provide a notification indicating that the at least one returnedmedication is usable for completing the order of the other medication.

According to certain embodiments of the present disclosure, a method formanaging a return of a prepared medication is provided. The methodincludes receiving an identification of at least one returned medicationdelivered to a first location, and receiving an order for anothermedication. The method also includes determining whether the at leastone returned medication is usable for completing the order of the othermedication, and when the determination indicates that the at least onereturned medication is usable for completing the order of the othermedication, providing a notification indicating that the at least onereturned medication is usable for completing the order of the othermedication.

According to certain embodiments of the present disclosure, amachine-readable storage medium that includes machine-readableinstructions for causing a processor to execute a method for managing areturn of a prepared medication is provided. The method includesreceiving an identification of at least one returned medicationdelivered to a first location, and receiving an order for anothermedication. The method also includes determining whether the at leastone returned medication is usable for completing the order of the othermedication, and when the determination indicates that the at least onereturned medication is usable for completing the order of the othermedication, providing a notification indicating that the at least onereturned medication is usable for completing the order of the othermedication.

It is understood that other configurations of the subject technologywill become readily apparent to those skilled in the art from thefollowing detailed description, wherein various configurations of thesubject technology are shown and described by way of illustration. Aswill be realized, the subject technology is capable of other anddifferent configurations and its several details are capable ofmodification in various other respects, all without departing from thescope of the subject technology. Accordingly, the drawings and detaileddescription are to be regarded as illustrative in nature and not asrestrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide furtherunderstanding and are incorporated in and constitute a part of thisspecification, illustrate disclosed embodiments and together with thedescription serve to explain the principles of the disclosedembodiments. In the drawings:

FIG. 1 illustrates an example architecture for managing a return of aprepared medication.

FIG. 2 is a block diagram illustrating an example server from thearchitecture of FIG. 1 according to certain aspects of the disclosure.

FIG. 3 illustrates an example process for managing a return of aprepared medication using the server of FIG. 2.

FIG. 4 is an example illustration associated with the example process ofFIG. 3.

FIG. 5 is a block diagram illustrating an example computer system withwhich the server of FIG. 2 can be implemented.

DETAILED DESCRIPTION

In the following detailed description, numerous specific details are setforth to provide a full understanding of the present disclosure. It willbe apparent, however, to one ordinarily skilled in the art that theembodiments of the present disclosure may be practiced without some ofthese specific details. In other instances, well-known structures andtechniques have not been shown in detail so as not to obscure thedisclosure.

The disclosed system provides a delivery person who is deliveringinfusion solutions to a particular area of a healthcare facility with alist of discontinued infusion solutions and their location in the areato which the delivery person is delivering. The delivery person may thenretrieve the discontinued infusion solutions and return them to apharmacy location providing services within a facility. The discontinuedinfusion solutions may be scanned upon their return to the pharmacy andlisted in an inventory of available infusion solutions. In certainaspects, the discontinued infusion solutions may be scanned wheninitially retrieved by the delivery person and also be listed in theinventory of available solutions. If the discontinued infusion solutionshave passed their expiration date, or are not within a threshold timeduration of their expiration date, e.g., exceeding the amount of timerequired to deliver to and administer the infusion solution at anotherlocation, then the discontinued infusion solutions are discarded.However, if the discontinued infusion solutions are not within thethreshold time duration of their expiration date, the discontinuedinfusion solutions are re-entered into inventory for possible re-use. Incertain aspects, the expiration date of an infusion solution can beautomatically determined based on the stability and sterility of themedication.

When a new order for an infusion solution is received, the disclosedsystem first checks whether the discontinued infusion solution that hasbeen re-entered into inventory can be used to fill the new order. If theorder can be filled with the discontinued infusion solution, then thediscontinued infusion solution is used for the order. However, if theorder cannot be filled with the discontinued infusion solution, then theorder is placed in an infusion solution preparation queue forpreparation by a technician or pharmacist.

In certain aspects, the disclosed system may determine one or moremetrics regarding the number of discontinued infusion solutions that arere-entered into inventory and/or the number of discontinued infusionsolutions that are discarded. The disclosed system may, for example,utilize the one or more metrics to adjust a suggested number of infusionsolutions that are prepared without any corresponding orders on a dailybasis, e.g., the number of fast mover pre-pack infusion solutions thatare prepared on a daily basis. For example, if a large number ofdiscontinued orders for a particular fast mover pre-pack infusionsolution is being re-entered into inventory on a daily basis, and thefast mover pre-pack infusion solutions subsequently expire before theycan be administered to a patient, the disclosed system may reduce thesuggested number of the fast mover pre-packs that should be prepared ona daily basis.

Turning now to the drawings, FIG. 1 illustrates an example architecture100 for managing a return of a prepared medication according to certainaspects of the present disclosure. For ease and clarity of illustrationonly, without any intent to limit the scope of the present disclosureany way, it is assumed that the prepared medication provided as anexample for FIG. 1 is an anesthetic IV solution.

The architecture 100 includes a pharmacy 1 having a medication storagearea 10, a fill and/or preparation (fill/prep) area 20, and a deliverypickup area 30 (e.g., bin-sorting area). The medication storage area 10includes a plurality of medications and supplies including, for example,an anesthetic drug (e.g., bupivacaine or chloroprocaine) and anappropriate fluid for the anesthetic drug. The anesthetic drug and thefluid are taken from the medication storage area 10 to the prep/fillarea 20 where they are mixed together to produce the anesthetic IVsolution. A patient/medication ID device 72, such as a barcode label ora radio frequency identification (RFID) tag, is provided on (e.g.,affixed to) a package 70 (e.g., IV bag) containing the IV solution atthe prep/fill area 20. The patient/medication ID device 72 includespatient/medication ID information indicative of the medication and thepatient to whom the medication is prescribed. The package 70 is thentaken by a technician at the pharmacy 1 to the delivery pickup area 30.The technician determines an appropriate bin or delivery cart 90 intowhich to place the package 70, and then loads the package 70 onto theappropriate delivery cart 90 for delivery to a scheduled delivery/droplocation 60 (e.g., a patient room) by a delivery person 2.

In the illustrated embodiment, the prep/fill area 20 has a barcodereader 24 provided therein that the technician at the pharmacy 1 can useto read the patient/medication ID device 72 (a barcode label in theillustrated example) before the package 70 is taken to the deliverypickup area 30. The delivery pickup area 30 has a barcode reader 34connected to a client 110 provided therein that the technician at thepharmacy 1 can use to read the patient/medication ID device 72 once thepackage 70 is taken to the delivery pickup area 30. The delivery cart 90may also be provided with a location barcode label reader. The deliveryperson 2 can use the barcode reader 34 to scan the package 70 toindicate the delivery person 2 will begin delivery of the package 70.

The pharmacy 1 includes a server 130 (e.g., pharmacy server) thatincludes a processor 40. The server 130 is coupled to an output device134, such as a display, and an input device 136, such as a keyboard. Theserver 130 can be any device having an appropriate processor, memory,and communications capability for receiving, processing, and sendinginformation associated with a medication database 45 and preparedmedications. The processor 40 is coupled to the medication database 45that is configured to store a variety of information including orderstatus information and delivery progress information to be discussedbelow. The processor 40 is configured to receive an identification of areturned package 70 (e.g., at the prep/fill area 20) and determine,based on the expiration date of the returned package 70, whether thereturned package 70 should be discarded, or kept for use in fillinganother potential order.

The processor 40 is configured to determine an expiration date for thereturned package 70 based on, for example, the stability and sterilityof the returned package 70. Information indicative of the stability andsterility of the returned package 70 may be obtained from the medicationdatabase 45. For example, the stability of the returned package 70,which indicates a length of time a drug in the returned package 70retains its properties without loss of potency (i.e., “shelf life”) caninitially be entered by a pharmacist or other health care provider whenthe returned package 70 is first prepared. The sterility of the returnedpackage, which indicates the conditions in which the package 70 wasprepared (e.g., an environment particle count), can be determined basedon a known location in which the package 70 was prepared as stored inthe medication database 45. For instance, if the package returnedpackage 70 is prepared in a sterile zone, it may be given a longerexpiration time frame than if the returned package 70 were not preparedin a sterile zone. The processor 40, based on a stability date enteredby a pharmacist and a sterility indicator calculated based on the knownlocation in which the package 70 was prepared, can then generate anexpiration date for the returned package 70.

The processor 40 may also identify a location (e.g., retrieval location50, such as a first patient room) of a discontinued package 70 that isready for return, and provide the identification of the discontinuedpackage 70 and of the retrieval location 50 to a client 110 for displayon an output device 114 at or near the delivery pickup area 30instructing the delivery person 2 to retrieve the discontinued package70 from the retrieval location 50. The client 110 can be, for example, acomputer system associated with the delivery pickup area 30 such as adesktop computer or mobile computer. The client 110 can also be, forexample, a tablet computer, mobile device (e.g., a smartphone or PDA),or any other device having appropriate processor, memory, andcommunications capabilities. The mobile device may, for example, beassociated with the delivery person 2.

The processor 40 is further configured to receive a new order formedication (e.g., from a doctor 3) for delivery to a delivery/droplocation 60, and determine whether the new order for the medication canbe filled using a returned prepared medication. The processor 40 is yetfurther configured to provide a notification, e.g., to output device 134in the pharmacy 1, as to whether the new order can be filled using areturned prepared medication. For example, a notification can bedisplayed on the output device 134 indicating that a returned preparedmedication for bupivacaine IV solution and be used to fill a new orderfor bupivacaine IV solution.

The delivery location 60 and/or the retrieval location 50 can include,for example, patient rooms having an infusion device for providing an IVinfusion from a package to a patient. In the illustrated example, theretrieval location 50 and the delivery location 60 are provided withlocation barcode label 52 and location barcode label 62, respectively.Each of the location barcode labels 52, 62 includes unique location IDinformation indicative of the respective location 50, 60 where thecorresponding barcode label is provided. As described above, the package70 (e.g., IV bag) containing the medication (e.g., IV solution) isprovided with a patient/medication identification (ID) device 72. In theillustrated example, the patient/medication ID device 72 is a barcodelabel that includes patient/medication information indicative of thepatient (e.g., “Jane Smith”) and the medication (e.g., “bupivacaine IVsolution”). The patient/medication information may also contain otherdrug or patient related information such as the patient's medicalconditions (e.g., allergies), name of the drug (e.g., bupivacaine), thedrug dosage, the drug concentration, the drug administration schedules,and the drug administration rate.

Also depicted in the architecture 100 of FIG. 1 is a reader device 84that is hand carried by the delivery person 2 and/or attached to thedelivery cart 90 and is configured to read the patient/medicationinformation from the patient/medication ID device 72 provided on thepackage 70. In the illustrated example, the reader device 84 is abarcode scanner. In those embodiments in which the barcode scanner 84 ishand carried by the delivery person 2, the scanner 84 is also configuredto read the location ID information from the location barcode labels 52,62, 92.

In the embodiments described above, the location ID devices 52, 62, 92and/or the patient/medication ID device 72 are passive ID devices,meaning that certain action (e.g., scanning) has to be taken by theparticipant (e.g., a pharmacy technician or the delivery person 2) toretrieve information therefrom. In other embodiments, the ID devices canbe active ID devices, meaning that the information retrieval from the IDdevices occur automatically without an action taken by the participant.In some embodiments, the active ID devices can actively transmit signalscontaining the relevant information to the reader device 72 through awireless link. The wireless link can use a variety of technologiesincluding Bluetooth, ZigBee, wireless USB, and proprietary systems. Inother embodiments, the active ID devices do not themselves transmitsignals, but respond to query signals generated by a reader device(e.g., by altering impedance of an RF circuit therein) as the readerdevice passes by the ID devices in close proximity.

In the illustrated example, each time the barcode scanner 84 scans an IDdevice (e.g., patient/medication ID device or location ID device), theinformation read thereby is wirelessly transmitted to a wireless bridge50 that receives the information. The bridge 50 is in data communicationwith the processor 40 via a hospital network 150. The network 150 caninclude, for example, any one or more of a personal area network (PAN),a local area network (LAN), a campus area network (CAN), a metropolitanarea network (MAN), a wide area network (WAN), a broadband network(BBN), the Internet, and the like. Further, the network 150 can include,but is not limited to, any one or more of the following networktopologies, including a bus network, a star network, a ring network, amesh network, a star-bus network, tree or hierarchical network, and thelike.

The processor 40 is configured to receive medication/patient IDinformation and/or location ID information read by the barcode scanner84, generate location, use, and re-use information therefrom, and storethe information in the medication database 45. The medication database45 can include information such as, but not limited to: the patient'sname or ID, the medication name or ID, the scheduled delivery location60, the scheduled delivery time, an expiration date or time for aprepared medication, an urgency of delivery of the prepared medication,a current location of the prepared medication, an order status of theprepared medication, a return status of the prepared medication, one ormore read locations where the medication/patient ID information and/orthe location ID information was read by the barcode scanner 84, timewhen the information was read, and the name or ID of the delivery person2.

The architecture 100 further comprises tracking devices 120, 152 thatallow a care provider 4 (e.g., a nurse assigned the task ofadministering the patient-specific medication to the patient) to monitorthe progress of the delivery of the medication. Each of the trackingdevices 120, 152 is configured to receive a tracking request by the careprovider 4, access the medication database 45, either directly or viathe processor 40, retrieve the delivery progress information stored inthe database 45, and indicate a delivery progress of the medication tothe care provider 4 based on the delivery progress information. In theillustrated example, the tracking device 120 is an automated dispensingmachine having a processor (not shown), a display 121, and a keyboard123; and the tracking device 152 is a mobile communication device (e.g.,a cell phone, personal digital assistant (PDA), or pager) having aprocessor (not shown), a display 151, and a keyboard 153. The deliveryprogress information can inform the care provider 4 of a last-known readlocation and time of the last reading. Based on such information, thecare provider 4 can decide, e.g., whether to wait for the delivery atthe delivery location 60, go to the delivery location later at anexpected delivery time, or go to the last-known location to retrieve themedication from the cart 90.

FIG. 2 is a block diagram 200 illustrating an example server 130 in thearchitecture 100 of FIG. 1 according to certain aspects of thedisclosure. The server 130 is connected to the network 150 via acommunications module 238. The communications module 238 is configuredto interface with the network 150 to send and receive information, suchas data, requests, responses, and commands to other devices on thenetwork. The communications module 238 can be, for example, a modem orEthernet card.

The server 130 includes the processor 40, the communications module 238,and a memory 232 that includes a medication database 45 and an ordertracking application 234. The processor 40 of the server 130 isconfigured to execute instructions, such as instructions physicallycoded into the processor 236, instructions received from software inmemory 240, or a combination of both. For example, the processor 236 ofthe server 130 executes instructions from the order tracking application234 to receive an identification of at least one returned medication(e.g., package 70) delivered to a first location, such as the prep/fillarea 20. The identification can be generated, for example, when thereturned medication is scanned by the barcode reader 24 at the prep/fillarea 20. For instance, when a delivery person 2 returns to the prep/fillarea 20 with a medication, a barcode label 72 of the medication can bescanned by the barcode reader 24 in order to indicate that themedication has been returned to the prep/fill area 20.

The processor 40 of the server 130 is also configured to execute theinstructions to provide, for display (e.g., to the output device 114 ofthe client 110), an identification of a location at which a medicationto be returned is located (e.g., retrieval location 52) for retrieval sothat the medication can be returned to the prep/fill area 20. Forexample, the processor 40 can send a message to a mobile device client110 of the delivery person 2 indicating a location of a package 70 thatshould be retrieved and returned to the prep/fill area 20.

When the processor 40 receives an order for another medication, theprocessor 40 is configured to determine whether the returned medicationis usable for completing the order of the other medication. Thedetermination can be based on, for example, a comparison between atleast two of an expiration time of the at least one returned medication,an estimated amount of time for delivering the at least one returnedmedication to a second location (e.g., delivery/drop location 60), anestimated time at which the at least one returned medication will beadministered to a patient at the second location, and a deliverydeadline for the other medication.

For example, if the returned medication is estimated to expire in tenminutes, and it is estimated to take thirty minutes to deliver thereturned medication to the delivery/drop location 60, then thedetermination may indicate that the returned medication cannot be usedfor completing the order of the other medication. As another example, ifthe order for the other medication must be delivered to thedelivery/drop location 60 within thirty minutes, and the estimated timeto deliver the returned medication to the delivery/drop location 60 isone hour, then the determination may indicate that the returnedmedication cannot be used for completing the order of the othermedication. As yet another example, if the returned medication isestimated to expire in one hour, it is estimated to take thirty minutesto deliver the returned medication to the delivery/drop location 60, andthe order for the other medication must be delivered to thedelivery/drop location 60 within forty-five minutes, then thedetermination may indicate that the returned medication can be used forcompleting the order of the other medication.

Accordingly, the processor 40 is configured to provide a notificationindicating that the returned medication is usable for completing theorder of the other medication when the determination indicates that thereturned medication is usable for completing the order of the othermedication. The notification can include, for example, an instruction toassist with preparation of the order of the other medication using theat least one returned medication. For instance, the notification canindicate that the returned medication should be combined with anotherreturned medication to fill the order. As an example, if two returnedmedications are each for Cefazolin (2 gm/NS 50 ml), and a new order forCefazolin (4 gm/NS 100 ml) is received by the processor 40, then theprocessor 40 can send a notification (e.g., to the output device 134)indicating that the two returned medications of Cefazolin (2 gm/NS 50ml) should be combined to fill the new order for Cefazolin (4 gm/NS 100ml).

Similarly, the processor 40 may be configured to provide a notificationindicating to proceed with completing the order of the other medicationwhen the determination indicates that the returned medication is notusable for completing the order of the other medication. For example, ifthe order for the other medication must be delivered to thedelivery/drop location 60 within thirty minutes, and the estimated timeto deliver the returned medication to the delivery/drop location 60 isone hour, then a notification on the output device 134 can indicate thatthe returned medication cannot be used for completing the order of theother medication. In certain aspects, the same notification or anothernotification can be provided by the processor 40 indicating the returnedmedication is expired, or the returned medication will expire within athreshold time period. The threshold time period may be based on anexpiration time of the returned medication and an estimated amount oftime for delivering the returned medication to the delivery/droplocation 60.

In certain aspects, the processor 40 is configured to receive anidentification of multiple medications returned to the first location(e.g., the prep/fill area 20) within a time period. The multiplereturned medications may have been prepared, for example, in response toa recurring order to prepare medications that includes a number of themedications to be prepared. For example, the medication database 45 mayinclude an order to prepare twenty IV bags of Vancomycin (1 m/NS 50 ml)every day. The processor 40 may determine, based on at least one of afrequency of return of the medications, a total number of medicationsreturned within the time period, and a frequency of expiration of thereturned medications prior to delivery to the delivery/drop location 60,whether to modify the recurring order. For example, the processor 40 mayidentify that, on average, ten of the twenty prepared IV bags ofVancomycin (1 gm/NS 50 ml) are returned and discarded every day. Theprocessor 40 may then modify the number of medications to be preparedbased on the determination. For example, if the processor 40 identifiesthat, on average, ten of the twenty prepared IV bags of Vancomycin (1gm/NS 50 ml) are returned and discarded every day, then the processor 40may modify the recurring order in the medication database 45 to indicatethat ten, not twenty, IV bags of Vancomycin (1 gm/NS 50 ml) should beprepared every day.

FIG. 3 illustrates an example process 300 for managing a return of aprepared medication using the example server 130 of FIG. 2. While FIG. 3is described with reference to FIG. 2, it should be noted that theprocess steps of FIG. 3 may be performed by other systems.

The process 300 begins by proceeding from beginning step 301 to when aprepared medication is identified for retrieval to step 302 when theserver 130 provides, for display (e.g., on client 110), anidentification of a location at which the prepared medication is locatedfor retrieval. Next, in step 303, an identification of the retrievedprepared medication is received upon delivery of the retrievedmedication to the preparation location (e.g., prep/fill area 20), forexample, when the retrieved prepared medication is scanned (e.g., usingbar code reader 24) at the preparation location.

In step 304, an order for another medication is received. In decisionstep 305, a determination is made whether the retrieved medication isusable for completing the order of the other medication (e.g., of step304) based on, for example, a comparison between at least two of anexpiration time of the retrieved medication, an estimated amount of timefor delivering the retrieved medication to a delivery location, and adelivery deadline for the other medication.

If the determination of decision step 305 indicates that the retrievedmedication is usable for completing the order of the other medication,then the process 300 proceeds to step 305 in which a notification isprovided indicating that the retrieved medication is usable forcompleting the order of the other medication. Next, in optional step306, an instruction to assist with preparation of the order of the othermedication using the retrieved medication is optionally provided. Theprocess 300 then ends in step 309.

If the determination of decision step 305 indicates that the retrievedmedication is not usable for completing the order of the othermedication, then the process 300 proceeds to step 307 in which anotification is provided indicating to proceed with completing the orderof the other medication. The process 300 then ends in step 309.

FIG. 3 set forth an example process 300 for managing a return of aprepared medication using the example server 130 of FIG. 2. An examplewill now be described using the example process 300 of FIG. 3 and a neworder for Cefazolin (2 gm/NS 50 ml).

The process 300 begins by proceeding from beginning step 301 to when aprepared medication, Cefazolin (2 gm/NS 50 ml) expiring at 10:00 PM, isidentified for retrieval from a retrieval location 50, patient room3NW-5, to step 302 when the server 130 provides, for display (e.g., on amobile device client 110 of a delivery person 2), an identification ofthe retrieval location 50 for the Cefazolin (2 gm/NS 50 ml). After thedelivery person 2 retrieves the Cefazolin (2 gm/NS 50 ml) and arrives atthe prep/fill area 20, then in step 303, an identification of theretrieved Cefazolin (2 gm/NS 50 ml) is received by the server 130 whenthe retrieved Cefazolin (2 gm/NS 50 ml) is scanned using the bar codereader 24 at the prep/fill area 20.

In step 304, a new order for Cefazolin (2 gm/NS 50 ml) to be deliveredto delivery/drop location 60, patient room 5E-12, by 8:00 AM isreceived. In decision step 305, a determination is made whether theretrieved Cefazolin (2 gm/NS 50 ml) is usable for completing the neworder of Cefazolin (2 gm/NS 50 ml) of step 304 based on a comparisonbetween the expiration time of the retrieved Cefazolin (2 gm/NS 50 ml),10:00 PM, an estimated amount of time for delivering the retrievedCefazolin (2 gm/NS 50 ml ) to delivery/drop location 60, thirty minutes,and a delivery deadline of 8:00 AM for delivering the Cefazolin (2 gm/NS50 ml) to delivery/drop location 60.

The determination of decision step 305 indicates that the retrievedCefazolin (2 gm/NS 50 ml) from patient room 3NW-5 is usable forcompleting the new order of Cefazolin (2 gm/NS 50 ml) for patient room5E-12, so the process 300 proceeds to step 305 in which a notificationis provided on the output device 134 of the server 130 indicating thatthe retrieved Cefazolin (2 gm/NS 50 ml) from patient room 3NW-5 isusable for completing the new order of Cefazolin (2 gm/NS 50 ml) forpatient room 5E-12.

FIG. 4 provides an example illustration 400 of a graphical userinterface for displaying the notification on the output device 134 ofthe server 130. The graphical user interface includes an identificationof the current time 402, 6:45 AM, and a list of 50 unchecked orders 406that may be sorted by, for example, priority, due time, location, oralphabetically and may be searched using a search interface 404. Fiveorders 408, 410, 412, 414, and 416 are listed and additional orders maybe viewed by scrolling the interface below the five listed orders 408,410, 412, 414, and 416. For each order, a due time, patient location,medication information, level of priority, and return status may beindicated. For example, the first order 408 listed identifies themedication as Cefazolin (2 gm/NS 5 ml) to be delivered to patient room5E-12 by 8:00 AM. The second order 410 listed identifies that themedication Cefazolin (2 gm/NS 5 ml) has been returned 418, and has anexpiration time of 10:00 PM.

The user interface also includes a messages area 418 that identifies 420the new order of medication of step 304, namely the order for Cefazolin(2 gm/NS 5 ml) to be delivered to patient room 5E-12 by 8:00 AM, butalso includes a notification 422 (of step 306) to be read by thepharmacist filling the new order. The notification 422 indicates to thepharmacist that that the second listed order 410, Cefazolin (2 gm/NS 50ml) returned from patient room 3NW-5 at 5:32 AM, may be used to fill thenew order for Cefazolin (2 gm/NS 5 ml). The process 300 then ends instep 308.

An instruction may optionally be displayed in step 306 to assist thepharmacist with preparation of the order of the other medication usingthe retrieved Cefazolin (2 gm/NS 50 ml). The instruction can be, forexample, a statement indicating that the retrieved Cefazolin (2 gm/NS 50ml) does not need to be altered to fill the new order for Cefazolin (2gm/NS 50 ml). The process 300 then ends in step 309.

FIG. 5 is a block diagram illustrating an example computer system 500with which the server 130 of FIG. 2 can be implemented. In certainaspects, the computer system 500 may be implemented using hardware or acombination of software and hardware, either in a dedicated server, orintegrated into another entity, or distributed across multiple entities.

Computer system 500 (e.g., server 130) includes a bus 508 or othercommunication mechanism for communicating information, and a processor502 (e.g., processor 40) coupled with bus 508 for processinginformation. By way of example, the computer system 500 may beimplemented with one or more processors 502. Processor 502 may be ageneral-purpose microprocessor, a microcontroller, a Digital SignalProcessor (DSP), an Application Specific Integrated Circuit (ASIC), aField Programmable Gate Array (FPGA), a Programmable Logic Device (PLD),a controller, a state machine, gated logic, discrete hardwarecomponents, or any other suitable entity that can perform calculationsor other manipulations of information.

Computer system 500 can include, in addition to hardware, code thatcreates an execution environment for the computer program in question,e.g., code that constitutes processor firmware, a protocol stack, adatabase management system, an operating system, or a combination of oneor more of them stored in an included memory 504 (e.g., memory 232),such as a Random Access Memory (RAM), a flash memory, a Read Only Memory(ROM), a Programmable Read-Only Memory (PROM), an Erasable PROM (EPROM),registers, a hard disk, a removable disk, a CD-ROM, a DVD, or any othersuitable storage device, coupled to bus 508 for storing information andinstructions to be executed by processor 502. The processor 502 and thememory 504 can be supplemented by, or incorporated in, special purposelogic circuitry.

The instructions may be stored in the memory 504 and implemented in oneor more computer program products, i.e., one or more modules of computerprogram instructions encoded on a computer readable medium for executionby, or to control the operation of, the computer system 500, andaccording to any method well known to those of skill in the art,including, but not limited to, computer languages such as data-orientedlanguages (e.g., SQL, dBase), system languages (e.g., C, Objective-C,C++, Assembly), architectural languages (e.g., Java, .NET), andapplication languages (e.g., PHP, Ruby, Perl, Python). Instructions mayalso be implemented in computer languages such as array languages,aspect-oriented languages, assembly languages, authoring languages,command line interface languages, compiled languages, concurrentlanguages, curly-bracket languages, dataflow languages, data-structuredlanguages, declarative languages, esoteric languages, extensionlanguages, fourth-generation languages, functional languages,interactive mode languages, interpreted languages, iterative languages,list-based languages, little languages, logic-based languages, machinelanguages, macro languages, metaprogramming languages, multiparadigmlanguages, numerical analysis, non-English-based languages,object-oriented class-based languages, object-oriented prototype-basedlanguages, off-side rule languages, procedural languages, reflectivelanguages, rule-based languages, scripting languages, stack-basedlanguages, synchronous languages, syntax handling languages, visuallanguages, wirth languages, embeddable languages, and xml-basedlanguages. Memory 504 may also be used for storing temporary variable orother intermediate information during execution of instructions to beexecuted by processor 502.

A computer program as discussed herein does not necessarily correspondto a file in a file system. A program can be stored in a portion of afile that holds other programs or data (e.g., one or more scripts storedin a markup language document), in a single file dedicated to theprogram in question, or in multiple coordinated files (e.g., files thatstore one or more modules, subprograms, or portions of code). A computerprogram can be deployed to be executed on one computer or on multiplecomputers that are located at one site or distributed across multiplesites and interconnected by a communication network. The processes andlogic flows described in this specification can be performed by one ormore programmable processors executing one or more computer programs toperform functions by operating on input data and generating output.

Computer system 500 further includes a data storage device 506 such as amagnetic disk or optical disk, coupled to bus 508 for storinginformation and instructions. Computer system 500 may be coupled viainput/output module 510 to various devices (e.g., barcode reader 24).The input/output module 510 can be any input/output module. Exampleinput/output modules 510 include data ports such as USB ports. Theinput/output module 510 is configured to connect to a communicationsmodule 512. Example communications modules 512 (e.g., communicationsmodule 238) include networking interface cards, such as Ethernet cardsand modems. In certain aspects, the input/output module 510 isconfigured to connect to a plurality of devices, such as an input device514 (e.g., input device 136) and/or an output device 516 (e.g., outputdevice 134). Example input devices 514 include a keyboard and a pointingdevice, e.g., a mouse or a trackball, by which a user can provide inputto the computer system 500. Other kinds of input devices 514 can be usedto provide for interaction with a user as well, such as a tactile inputdevice, visual input device, audio input device, or brain-computerinterface device. For example, feedback provided to the user can be anyform of sensory feedback, e.g., visual feedback, auditory feedback, ortactile feedback; and input from the user can be received in any form,including acoustic, speech, tactile, or brain wave input. Example outputdevices 516 include display devices, such as a LED (light emittingdiode), CRT (cathode ray tube), or LCD (liquid crystal display) screen,for displaying information to the user.

According to one aspect of the present disclosure, the and server 130can be implemented using a computer system 500 in response to processor502 executing one or more sequences of one or more instructionscontained in memory 504. Such instructions may be read into memory 504from another machine-readable medium, such as data storage device 506.Execution of the sequences of instructions contained in main memory 504causes processor 502 to perform the process steps described herein. Oneor more processors in a multi-processing arrangement may also beemployed to execute the sequences of instructions contained in memory504. In alternative aspects, hard-wired circuitry may be used in placeof or in combination with software instructions to implement variousaspects of the present disclosure. Thus, aspects of the presentdisclosure are not limited to any specific combination of hardwarecircuitry and software.

Various aspects of the subject matter described in this specificationcan be implemented in a computing system that includes a back endcomponent, e.g., as a data server, or that includes a middlewarecomponent, e.g., an application server, or that includes a front endcomponent, e.g., a client computer having a graphical user interface ora Web browser through which a user can interact with an implementationof the subject matter described in this specification, or anycombination of one or more such back end, middleware, or front endcomponents. The components of the system can be interconnected by anyform or medium of digital data communication, e.g., a communicationnetwork. The communication network (e.g., network 150) can include, forexample, any one or more of a personal area network (PAN), a local areanetwork (LAN), a campus area network (CAN), a metropolitan area network(MAN), a wide area network (WAN), a broadband network (BBN), theInternet, and the like. Further, the communication network can include,but is not limited to, for example, any one or more of the followingnetwork topologies, including a bus network, a star network, a ringnetwork, a mesh network, a star-bus network, tree or hierarchicalnetwork, or the like. The communications modules can be, for example,modems or Ethernet cards.

Computing system 500 can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.Computer system 500 can be, for example, and without limitation, adesktop computer, laptop computer, or tablet computer. Computer system500 can also be embedded in another device, for example, and withoutlimitation, a mobile telephone, a personal digital assistant (PDA), amobile audio player, a Global Positioning System (GPS) receiver, a videogame console, and/or a television set top box.

The term “machine-readable storage medium” or “computer readable medium”as used herein refers to any medium or media that participates inproviding instructions or data to processor 502 for execution. Such amedium may take many forms, including, but not limited to, non-volatilemedia, volatile media, and transmission media. Non-volatile mediainclude, for example, optical disks, magnetic disks, or flash memory,such as data storage device 506. Volatile media include dynamic memory,such as memory 504. Transmission media include coaxial cables, copperwire, and fiber optics, including the wires that comprise bus 508.Common forms of machine-readable media include, for example, floppydisk, a flexible disk, hard disk, magnetic tape, any other magneticmedium, a CD-ROM, DVD, any other optical medium, punch cards, papertape, any other physical medium with patterns of holes, a RAM, a PROM,an EPROM, a FLASH EPROM, any other memory chip or cartridge, or anyother medium from which a computer can read. The machine-readablestorage medium can be a machine-readable storage device, amachine-readable storage substrate, a memory device, a composition ofmatter effecting a machine-readable propagated signal, or a combinationof one or more of them.

As used herein, the phrase “at least one of” preceding a series ofitems, with the terms “and” or “or” to separate any of the items,modifies the list as a whole, rather than each member of the list (i.e.,each item). The phrase “at least one of” does not require selection ofat least one item; rather, the phrase allows a meaning that includes atleast one of any one of the items, and/or at least one of anycombination of the items, and/or at least one of each of the items. Byway of example, the phrases “at least one of A, B, and C” or “at leastone of A, B, or C” each refer to only A, only B, or only C; anycombination of A, B, and C; and/or at least one of each of A, B, and C.

Furthermore, to the extent that the term “include,” “have,” or the likeis used in the description or the claims, such term is intended to beinclusive in a manner similar to the term “comprise” as “comprise” isinterpreted when employed as a transitional word in a claim.

A reference to an element in the singular is not intended to mean “oneand only one” unless specifically stated, but rather “one or more.” Theterm “some” refers to one or more. Underlined and/or italicized headingsand subheadings are used for convenience only, do not limit the subjecttechnology, and are not referred to in connection with theinterpretation of the description of the subject technology. Allstructural and functional equivalents to the elements of the variousconfigurations described throughout this disclosure that are known orlater come to be known to those of ordinary skill in the art areexpressly incorporated herein by reference and intended to beencompassed by the subject technology. Moreover, nothing disclosedherein is intended to be dedicated to the public regardless of whethersuch disclosure is explicitly recited in the above description.

While this specification contains many specifics, these should not beconstrued as limitations on the scope of what may be claimed, but ratheras descriptions of particular implementations of the subject matter.Certain features that are described in this specification in the contextof separate embodiments can also be implemented in combination in asingle embodiment. Conversely, various features that are described inthe context of a single embodiment can also be implemented in multipleembodiments separately or in any suitable subcombination. Moreover,although features may be described above as acting in certaincombinations and even initially claimed as such, one or more featuresfrom a claimed combination can in some cases be excised from thecombination, and the claimed combination may be directed to asubcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings in a particularorder, this should not be understood as requiring that such operationsbe performed in the particular order shown or in sequential order, orthat all illustrated operations be performed, to achieve desirableresults. In certain circumstances, multitasking and parallel processingmay be advantageous. Moreover, the separation of various systemcomponents in the aspects described above should not be understood asrequiring such separation in all aspects, and it should be understoodthat the described program components and systems can generally beintegrated together in a single software product or packaged intomultiple software products.

The subject matter of this specification has been described in terms ofparticular aspects, but other aspects can be implemented and are withinthe scope of the following claims. For example, the actions recited inthe claims can be performed in a different order and still achievedesirable results. As one example, the processes depicted in theaccompanying figures do not necessarily require the particular ordershown, or sequential order, to achieve desirable results. In certainimplementations, multitasking and parallel processing may beadvantageous. Other variations are within the scope of the followingclaims.

These and other implementations are within the scope of the followingclaims.

What is claimed is:
 1. A system, comprising: one or more activeidentification devices configured to transmit information when within aproximity of a reader device without a further scanning action taken bya participant; one or more processors; and a machine-readable memoryhaving instructions stored thereon that, when executed by the one ormore processors, cause a first computing device to perform operationscomprising: identifying a first medication at a first location within ahealthcare facility to be returned to a second location within thehealthcare facility; providing, to a remote computing device separatefrom the system, instructions to retrieve the first medication from thefirst location; receiving a first indication that the first medicationis available for re-use before it is returned to the second location,the first indication including information automatically obtainedwirelessly from an active identification device affixed to a containerof the first medication by the reader device when the activeidentification device was within the proximity of the reader device;receiving an order for a second medication; determining whether thefirst medication is usable for completing the order of the secondmedication prior to a delivery time associated with the secondmedication; providing, when the first medication is determined to beusable, for display at a display device, a first notification indicatingthat the first medication is usable for completing the order.
 2. Thesystem of claim 1, wherein the operations further comprise: determiningan expiration time of the first medication, and a delivery location ofthe second medication, wherein the operations determine whether thefirst medication is us usable for completing the order of the secondmedication prior to the delivery time based on the expiration time ofthe first medication and the delivery location of the second medication.3. The system of claim 1, wherein the operations further comprise:determining that the first medication is usable for completing the orderof the second medication prior to the delivery time associated with thesecond medication; receiving a second indication that the firstmedication was received at the second location; and providing,responsive to receiving the second indication, for display at thedisplay device, a second notification indicating that the firstmedication was received at the second location.
 4. The system of claim3, wherein the instructions are provided after determining that thefirst medication is usable.
 5. The system of claim 1, wherein the firstmedication or the second medication is designated for use by an infusiondevice.
 6. The system of claim 1, wherein the remote computing device isa mobile device associated with delivery personal.
 7. The system ofclaim 1, wherein the operations further comprise: determining that thefirst medication cannot be used for completing the order of the secondmedication prior to the delivery time associated with the secondmedication; and providing, for display at the display device, a secondnotification indicating to proceed with completing the order of thesecond medication.
 8. The system of claim 1, wherein the operationsfurther comprise: receiving delivery progress information for arespective medication based on a scanning of a respective activeidentification device affixed to a container of the respectivemedication at one or more locations within the healthcare facility;receiving, from a second computing device, a request from a careprovider for location information associated with the respectivemedication; and providing, to a second computing device, the locationinformation including a last-known location of the respectivemedication.
 9. The system of claim 8, wherein the second computingdevice is a mobile device assigned to the care provider or a automateddispensing machine.
 10. A method, comprising: identifying a firstmedication at a first location within a healthcare facility to bereturned to a second location within the healthcare facility; providing,to a remote computing device, instructions to retrieve the firstmedication from the first location; receiving a first indication thatthe first medication is available for re-use before it is returned tothe second location, the first indication including informationautomatically obtained wirelessly from an active identification deviceaffixed to a container of the first medication by a reader device whenthe active identification device was within a proximity of the readerdevice; receiving an order for a second medication; determining whetherthe first medication is usable for completing the order of the secondmedication prior to a delivery time associated with the secondmedication; providing, when the first medication is determined to beusable, for display at a display device, a first notification indicatingthat the first medication is usable for completing the order.
 11. Themethod of claim 10, further comprising: determining an expiration timeof the first medication, and a delivery location of the secondmedication, wherein determining whether the first medication is usablefor completing the order of the second medication prior to the deliverytime is based on the expiration time of the first medication and thedelivery location of the second medication.
 12. The method of claim 10,further comprising: determining that the first medication is usable forcompleting the order of the second medication prior to the delivery timeassociated with the second medication; receiving a second indicationthat the first medication was received at the second location; andproviding, responsive to receiving the second indication, for display atthe display device, a second notification indicating that the firstmedication was received at the second location.
 13. The method of claim10, wherein the first medication or the second medication is designatedfor use by an infusion device.
 14. The method of claim 10, wherein theremote computing device is a mobile device associated with deliverypersonal.
 15. The method of claim 10, further comprising: determiningthat the first medication cannot be used for completing the order of thesecond medication prior to the delivery time associated with the secondmedication; and providing, for display at the display device, a secondnotification indicating to proceed with completing the order of thesecond medication.
 16. The method of claim 10, further comprising:receiving delivery progress information for a respective medicationbased on a scanning of a respective active identification device affixedto a container of the respective medication at one or more locationswithin the healthcare facility; receiving, from a second computingdevice, a request from a care provider for location informationassociated with the respective medication, the second computing devicecomprising a mobile device assigned to the care provider or a automateddispensing machine; and providing, to a second computing device, thelocation information including a last-known location of the respectivemedication.
 17. A non-transitory machine readable memory device storinginstructions thereon that, when executed, cause a first computing deviceto perform operations comprising: identifying a first medication at afirst location within a healthcare facility to be returned to a secondlocation within the healthcare facility; providing, to a remotecomputing device separate from the first computing device, instructionsto retrieve the first medication from the first location; receiving,after providing the instructions, a first indication that the firstmedication is available for re-use before it is returned to the secondlocation, the first indication including information automaticallyobtained wirelessly from an active identification device affixed to acontainer of the first medication by a reader device when the activeidentification device was within a proximity of the reader device;receiving an order for a second medication; determining whether thefirst medication is usable for completing the order of the secondmedication prior to a delivery time associated with the secondmedication; providing, when the first medication is determined to beusable, for display at a display device, a first notification indicatingthat the first medication is usable for completing the order.
 18. Thenon-transitory machine readable memory device of claim 17, wherein theoperations further comprise: determining that the first medication isusable for completing the order of the second medication prior to thedelivery time associated with the second medication; receiving a secondindication that the first medication was received at the secondlocation; and providing, responsive to receiving the second indication,for display at the display device, a second notification indicating thatthe first medication was received at the second location.
 19. Thenon-transitory machine readable memory device of claim 17, wherein theoperations further comprise: determining that the first medicationcannot be used for completing the order of the second medication priorto the delivery time associated with the second medication; andproviding, for display at the display device, a second notificationindicating to proceed with completing the order of the secondmedication.
 20. The non-transitory machine readable memory device ofclaim 17, wherein the operations further comprise: receiving deliveryprogress information for a respective medication based on a scanning ofa respective active identification device affixed to a container of therespective medication at one or more locations within the healthcarefacility; receiving, from a second computing device, a request from acare provider for location information associated with the respectivemedication, the second computing device comprising a mobile deviceassigned to the care provider or a automated dispensing machine; andproviding, to a second computing device, the location informationincluding a last-known location of the respective medication.